Skip to main content

Zusammenfassung

Die rezepturmäßige Verdünnung stark wirkender Corticoid-Dermatica des Handels ist zu einem von Ärzten, Apothekern und Arzneifabrikanten heftig umstrittenen Thema geworden. Es wird der Versuch einer Sichtung der Publikationen unternommen, die sich mit dem Thema beschäftigen und die Pro und Contra dieser Praxis zur Diskussion stellen. So werden nach einer Begründung der Rezeptur von Verdünnungen deren galenische, biopharmazeutische, chemische und mikrobiologische Aspekte besprochen. Schließlich wird auf Alternativlösungen hingewiesen, die der Erhöhung der Therapiesicherheit dienen.

Summary

Prescription of potent topical corticoid preparations diluted with various vehicles has become an issue of disputation among physicians, pharmacists, and pharmaceutical firms. The recent literature on this problem is reviewed and discussed with particular respect of the reasons of “pro” and “contra” of this prescriptive practice in medicine. Various risky aspects of dilutory formulation with regard to pharmaceutics, biopharmaceutics, chemistry, and microbiology are pointed out. Some alternative proposals to improve the safety of therapy is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  • Altmeyer, P.: Über die Wirksamkeit von Steroidsalben unterschiedlicher Konzentration. Eine experimentelle Studie. Ärztl. Kosmetol. 10, 311 (1980).

    Google Scholar 

  • Asche, H, Gay, M u.a.: Einfluß des Behälters auf die Anfälligkeit von Dermatika-Grundlagen gegenüber mikrobieller Kontamination. Pharm. Industrie 40, 1212 (1978).

    Google Scholar 

  • Baird, R M, Brown, W R L, Shooter, R A.: Pseudomonas aeruginosa in hospital pharmacies. Brit. med. J. 1, 511 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Borovian, G E.: Pseudomonas cepacia: growth in and adaptability to increased preservative concentrations. J. Soc. Cosmet. Chem. 34, 197 (1983).

    Google Scholar 

  • Brookes, FL, Hugo, W B, Denyer, S P.: Transformation of betamethason 17-valerate by skin microflora. J. Pharm. Pharmacol. (Lond.) 33, 74 P (1981).

    Google Scholar 

  • Bundgaard, H.: The possible implication of steroid-glyoxal degradation products in allergic reactions to corticosteroids. Arch. Pharm. Chem., Sci. Ed. (Kbh.) 8, 83 (1980).

    CAS  Google Scholar 

  • Bundgaard, H, Hansen, J.: Studies on the stability of corticosteroids. IV. Formation and degradation kinetics of 21-dehydrocorticosteroids, key intermediates in the oxidative decomposition of 21- hydroxy corticosteroids. Arch. Pharm. Chem., Sci. Ed. (Kbh.) 8, 187 (1980).

    CAS  Google Scholar 

  • Bundgaard, H, Hansen, J.: Studies on the stability of corticosteroids. VI. Kinetics of the rearrangement of betamethasone-17-valerate to the 21-va- lerate ester in aqueous solution. Intern. J. Pharmaceut. (Amsterdam) 7, 197 (1981).

    CAS  Google Scholar 

  • Burdick, K H, Poulsen, B, Place, V A.: Extemporaneous formulation of corticosteroids for topical usage. JAMA 211, 462 (1970).

    Article  PubMed  CAS  Google Scholar 

  • Busse, M J.: Dangers of dilution of topical steroids. Pharm. J. (Lond.) 220, 25 (1978).

    Google Scholar 

  • Busse, M J, Hunt, P u.a.: Release of betamethasone derivatives from ointments — in vivo and in vitro studies. Brit. J. Derm. 81, Suppl. 4, 103 (1969).

    Article  CAS  Google Scholar 

  • Champion, R N, Goldin, D.: Clinical aspects of topical therapy. Pharm. J. (Lond.) 218, 328 (1975).

    Google Scholar 

  • Clement, M, Hehir, M u.a.: The effect of epidermal DNA synthesis of a combination of topical steroid with either dithranol or tar as used for psoriasis. Brit. J. Derm. 109, 327 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Das Gupta V: Stability of triamcinolone acetonide solutions as determined by high-performance chromatography, J. Pharm. Sci. 72, 1453 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Dolder, R.: Inkompatibilitäten bei der Therapie mit dermatologischen Externa. Aktuelle. Derm. 6, 213 (1980).

    Google Scholar 

  • Feather, J W, Ryatt, K S u.a.: Reflectance spectrophotometric quantification of skin colour changes induced by topical corticosteroid preparations. Brit. J. Derm. 106, 437 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Feuerstein, W.: Die Tätigkeit niedergelassener Dermatologen anhand einer Umfrage. Schrifttum u. Praxis 12, 54 (1981).

    Google Scholar 

  • Fröhlich, H H.: Externa zur Pflege und Behandlung der Haut; in Schneider, W., Fröhlich, H H.: Die Haut. Teil A. Pflege und Behandlung. Bayerische Landesapothekenkammer, München, 1979, p.42.

    Google Scholar 

  • Früh, H.: Einfluß von Urea in einem Kortikoid-Dermatikum auf die Vasokonstriktion. Z. Hautkr. 58, 1203 (1983).

    PubMed  Google Scholar 

  • Gardi, R, Vitali, R, Ercoli, A.: Derivati di condensazione nella catena laterale di corticosteroidi. Nota III. Preparazione e reazioni di 17-monoesteri. Gazz. chim. ital. 93, 431 (1963).

    Google Scholar 

  • Gardi, R.: New reactions in corticosteroid side chain; in Martini, L, Pecile, A.: Hormonal steroids. Academic Press, New York, London, 1965, p. 99.

    Google Scholar 

  • Gartmann, H.: Corticosteroide in der Behandlung von Dermatosen. Med. Mschr. Pharmazeut. 2, 45 (1979).

    CAS  Google Scholar 

  • Gibson, J R, Darley, C u.a.: The dilution of proprietary corticosteroid ointments - an attempt to evaluate relative clinical potencies. Brit. J. Derm. 106, 445 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Gibson, J R, Kirsch, J u.a.: An attempt to evaluate the relative potencies of various diluted and undiluted proprietary corticosteroid preparations. Brit. J. Derm. 109, Suppl. 25, 114 (1983).

    PubMed  Google Scholar 

  • Hadgraft, J W.: The changing pattern of topical dermatological therapy. J. Soc. Cosmet. Chem. 20, 663 (1969).

    Google Scholar 

  • Hadgraft, J W.: Recent progress in the formulation of vehicles for topical application. Brit. J. Derm. 87, 386 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Hallam, N F.: The use and abuse of topical corticosteroids in dermatology. Scott, med. J. 25, 287 (1980).

    CAS  Google Scholar 

  • Hansen, J, Bundgaard, H.: Studies on the stability of corticosteroids. I. Kinetics of degradation of hydrocortisone in aqueous solution. Arch. Pharm. Chem., Sci. Ed. (Kbh.) 7, 135 (1979).

    CAS  Google Scholar 

  • Hidaka, T u.a.: Studies on betamethasone: Behaviour of betamethasone in acid or alkaline medium, photolysis and oxidation. Yakugaku Zasshi. 100, 72 (1980).

    PubMed  Google Scholar 

  • Hoffmann, R-R.: Corticoidpräparate in der Hauttherapie; in Morck, H, Liekefeldt, H, Schneider, L.: Offizinpharmazie. Bd. 2. Gg. Thieme Verlag, Stuttgart, 1980, p. 42.

    Google Scholar 

  • Huber, H P, Pflugshaupt, Ch.: Ergebnisse einer systematischen Kortikoid-Grundlagen-Intervalltherapie. Schweiz. Rdsch. Med. (Praxis) 68, 821 (1979).

    CAS  Google Scholar 

  • Kessler, H-J.: Local antiseptics versus antibiotics in topical therapy - the emergence of microbial resistance. Mykosen 23, 285 (1980).

    PubMed  CAS  Google Scholar 

  • Kidd, K: Percutaneous absorption, vehicles and dermatological prescribing. Aust. J. Derm. 16, 60 (1975).

    Article  CAS  Google Scholar 

  • Kirsch, J M, Gibson, J R, Darley, C R.: The stability and blanching efficiency of betamethasone-17-valerate in emulsifying ointment. Brit. J. Derm. 108, 250 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Li Wan Po, A, Irwin, W J, Yip, Y W. (I): High-performance liquid chromatographic assay of betamethasone-17-valerate and its degradation products. J. Chromatogr. (Amst.) 176, 399 (1979).

    Google Scholar 

  • Li Wan Po, A, Irwin, W J, Yip, Y W (II): Stability of topical steroids. Proc. Analyt. Div. Chem. Soc. 1979, 333.

    Google Scholar 

  • Li Wan Po, A, Irwin, W J.: High-performance liquid chromatography - techniques and applications. J. Clin. Hosp. Pharmacy (Lond.) 5, 107 (1980).

    Google Scholar 

  • Magnus, A D, Haigh, J M, Kanfer, I.: Release of betamethasone 17-valerate from extemperaneous dilutions of a proprietaiy topical cream. Dermatologica (Basel) 163, 331 (1981).

    Article  CAS  Google Scholar 

  • Main, R A, White, M I.: Choice of topical corticosteroids. Practitioner 219, 456 (1977).

    PubMed  CAS  Google Scholar 

  • McKenzie, A W, Atkinson, R M.: Topical activities of betamethasone esters in man. Arch. Derm. (Chicago) 89, 741 (1964).

    Article  CAS  Google Scholar 

  • Mehta, A C, Calvert, R T, Ryatt, K S.: Betamethasone 17-valerate — An investigation into its stability in Betnovate after dilution with Emulsifying Ointment: quantitation of degradation products. Brit. J. Pharm. Pract. 4, 10 (1982).

    Google Scholar 

  • Miller, J A, Munro, D D.: Topical corticosteroids: clinical pharmacology and therapeutic use. Drugs 19, 119 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Mooney, A F.: Dilution of topical corticosteroid formulations. Brit. J. Derm. 90, 109 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Noble, W C, Savin, JA.: Steroid cream contaminated with Pseudomonas aeruginosa. Lancet 1966, I, 347.

    Article  Google Scholar 

  • Nowak, G A.: Mikrobiologische Anforderungen bei kosmetischen Mitteln. Parfüm, u. Kosmet. 60, 8 (1979); Die Konservierung kosmetischer und pharmazeutischer Produkte unter Berücksichtigung der GMP. ibid. 60, 130 (1979).

    Google Scholar 

  • Orr, NA, Hill, E A, Smith, J F.: Distribution of powdered drugs in ointment bases. Int. J. Pharm. Techn. Prod. Mfr. 1, 4 (1980).

    CAS  Google Scholar 

  • >Paetzold, O-H.: Zur Frage der Infektiosität mikrobiell verunreinigter Externa — Eine spezielle Studie —. Ärztl. Kosmetol. 11, 225 (1981).

    Google Scholar 

  • Pflugshaupt, Ch.: Diskontinuierliche topische Corticoidtherapie, Zbl. Haut- u. Geschl.-Kr. 148, 1229 (1983).

    Google Scholar 

  • Pierard, G-E.: La tachyphylaxie et les corticost6roides topiques. Nouv. Derm. 2, 8 (1983).

    Google Scholar 

  • Rauch, H J.: Anmerkungen zur Kurzzeitbehandlung der Psoriasis vulgaris mit Anthralin. Aktuelle Derm. 9, 120 (1983).

    Google Scholar 

  • Reynolds, E F, Prasad, A B.: Martindale - The Extra Pharmacopoeia, 28. Ed., The Pharmaceutical Press, London, 1982, p. 462.

    Google Scholar 

  • Ryatt, K S, Feather, J W u.a.: The stability and blanching efficacy of betamethasone-17-valerate in Emulsifying Ointment. Brit. J. Derm. 107, 71 (1982); 108, 251 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Savin, JA. (I): Pseudomonas aeruginosa infections in a skin ward. Trans. Rep. St. John’s Hosp. derm. Soc. (Lond.) 1967, 75.

    Google Scholar 

  • Savin, JA. (II): The microbiology of topical preparations in pharmaceutical praxis. 1. Clinical aspects. Pharmaceut. J. (Lond.) 1967, 285.

    Google Scholar 

  • Savin, J A.: Topical steroids and bacterial infection. Brit. J. Derm. 94, Suppl. 12, 125 (1976).

    Article  PubMed  Google Scholar 

  • Schalla, W.: Euromed-Gespräch: Kortison? - Warum nicht! Euromed 23, 476 (1983).

    Google Scholar 

  • Smith, J F.: The incidence of topical steroid dilutions. J. Clin. Hosp. Pharmacy (Lond.) 7, 137 (1982).

    CAS  Google Scholar 

  • Smith, J F, Beveridge, E G, Orr, NA.: Dilution of betamethasone ointment. Brit. J. Derm. 108, 248 (1983).

    Article  PubMed  CAS  Google Scholar 

  • Sneddon, I B.: Clinical use of topical corticosteroids. Drugs 11, 193 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Stoughton, R B.: Vasoconstrictor activity and percutaneous absorption of glucocorticosteroids: A direct comparison. Arch. Derm. (Chicago) 99, 753 (1969).

    Article  CAS  Google Scholar 

  • Stoughton, R B.: Topical corticoid therapy: A round table discussion, Part V. Cutis (N. Y.) 25, 441 (1980).

    Google Scholar 

  • The Pharmaceutical Codex, 11. Ed., The Pharmaceutical Press, London, 1979, p. 98, 99.

    Google Scholar 

  • The degradation of triamcinolone acetonide in aqueous solution: influence of the cyclic ketal function.

    Google Scholar 

  • Timmins P. u. Gray E A.: J. Pharmacol. 35, 175 (1983). - Transparenz-telegramm, A.T.I. Arzneimittelinformation Berlin GmbH, Berlin, 1983, p. 878.

    Article  CAS  Google Scholar 

  • Vitali, R, Gardi, R.: Hydrolysis of corticosteroid 17,21-alkylorthoesters in buffered medium. Farmaco, Ed. Sci. (Pavia) 27, 878 (1973).

    Google Scholar 

  • Wallhäußer, K H.: Die mikrobielle Reinheit von Arzneimitteln in der Hand des Verbrauchers. Dtsch. Apoth. Ztg. 118, 1510 (1978).

    Google Scholar 

  • Weirich, E G.: Zur Pharmakologie der Dermocorticoide. Z. Hautkr. 53, 189, 247 (1977).

    Google Scholar 

  • Weitgasser, H.: Erfahrungen mit magistraliter zubereiteten Verdünnungen eines neuen Flumethasonpivalat-Triclosan-Dermatikums in der dermatologischen Praxis. Ergebnisse einer multizentrischen Prüfung. Wien. med. Wschr. 1979, 193.

    Google Scholar 

  • Wendt, H, Frosch, P J.: Clinico-pharmacological models for the Assay of topical corticoids. Karger, Basel, 1982, p. 13.

    Google Scholar 

  • Whitefield, M.: Topical steroids. Lancet 1977, 925.

    Google Scholar 

  • Woodbridge, P A, Sparkes, C G.: Managing chronic skin conditions with two differing topical corticosteroids. Dermatologi- ca (Basel) 158, 299 (1979).

    Article  CAS  Google Scholar 

  • Woodford, R.: Investigation of the release characteristics of Unguentum Merck as a diluent for topical corticosteroid preparations. Curr. Ther. Res. Clin. Exp. 29, 17 (1981).

    CAS  Google Scholar 

  • Yip, Y W, Li Wan Po, A.: The stability of betamethasone-17-valerate in semi-solid bases. J. Pharm. Pharmacol. (Lond.) 31, 400 (1979).

    CAS  Google Scholar 

  • Yip, Y W, Li Wan Po, A, Irwin, W J.: Kinetics of decomposition and formulation of hydrocortisone butyrate in semiaqueous and gel systems. J. pharm. Sci. 72, 776 (1983).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1988 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Müller, K.H. (1988). Corticoid-Verdünnungen. In: Hornstein, O.P., Hundeiker, M., Schönfeld, J. (eds) Neue Entwicklungen in der Dermatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73581-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-73581-3_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-19142-1

  • Online ISBN: 978-3-642-73581-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics